NEW YORK STATE DEPARTMENT OF HEALTH AIDS INSTITUTE ehepqual- HCV Quality of Care Performance Measure Program USERS GUIDE A GUIDE FOR PRIMARY CARE AND HEPATITIS C CARE PROVIDERS * * For use with ehepqual, an electronic web-based program for quality of care data collection and review REVIEW PERIOD(S): January 1, 2017 December 31, 2017 1
PREFACE This document outlines the use of the ehepqual application to submit clinical indicator data to the New York State Department of Health AIDS Institute. Definitions for each indicator have been included in a separate reference document available within the Reference Materials section at www.ehepqual.org, the signin page for the use of ehepqual. The core functionality and design of ehepqual are similar to the version of the application used for the ehivqual system. Additional details are documented in this guide, the ehepqual Step-by-Step Chart Review Checklist, and ehepqual Data Collection Tool, all available under Reference Materials at www.ehepqual.org. If you plan to import data into ehepqual using XML or Excel format, rather than manually entering it, please note that data for your review need to be uploaded through a separate import process. This should be done after specifying the parameters for that review (review period start and end dates) but before keying in any additional data (which can be done after the data import for that review). 2
HOW TO USE THE APPLICATION -OVERVIEW The ehepqual application is designed to capture data and generate reports that enable the health care provider to assess the quality of care provided to patients infected with the hepatitis C virus (HCV). The key steps in this process are: A. Create the necessary review profile(s): A separate review profile will be created for each review period. For each profile, specify the review period dates this is done every time a new quality review is conducted. B. Obtain patient sample(s): For each program (site or clinic of the larger organization), consult the ehepqual Step-by-Step Chart Review document and obtain a random sample of eligible patients to populate the review. NOTE: Sampling may not be required if your system can generate the appropriate information as we have import procedures to automate the entry of patient data. Step C may not apply, depending on which data elements you are able to import. C. Enter patients for review: In ehepqual, populate each review profile for each program (site or clinic) with the required patient-defining information (name, DOB, etc.) and hepatitis related care and treatment for the patients in the sample. D. Generate reports using the report selector screen and review them with your HCV care team: Validation reports Aggregate Reports Dashboard Reports Indicator-specific reports E. Validate and correct data entry as needed based on review of reports (see the Ensuring Data Accuracy section of this document for details). F. Submit data First see the Final Steps before Submitting Data guide. Then, follow instructions in the Submit Data section of this document. Submitted data will be reviewed by the AIDS Institute, and within the next few days you will receive an e-mail confirmation or additional guidance. 3
HOW TO USE THE APPLICATION DATA ENTRY STEP-BY-STEP (1) Sign In The application is available at www.ehepqual.org. You can use any computer, at any time; all you need is a secure internet connection and your user ID and password. When you browse to this page, you will encounter the sign-in form: Enter your user name and password and then click on Submit. You will be directed to the home page for the application: The three tabs beneath the ehepqual logo (Programs, Reviews, Report List) provide access to most of the application functionality: program profiles are reviewed; review periods are specified and review data entered; and reports are run. In most cases, you will find that the program profile information has been pre-entered by the AIDS Institute. 4
(2) Create New Review Profile(s) To create a new review profile, click on the Reviews button on the home page and then click on Add New Review. This will bring you to the Review Details screen: 5
Only enter the review start and end dates at this point. Please note that the review start and end dates, 01/01/17 and 12/31/17, should be used for all submissions of 2017/2018 data to the AIDS Institute. Once you have entered the start and end date, click on Submit at the bottom of the page, and you will be brought back to the list of review periods, which now includes one for the current review period: You will return to this screen later, after completing all the data entry and running the reports, in order to complete the data submission process. 6
(3) Entering Patients to Review NOTE: Manual data entry may not be required if your data system can generate the appropriate information as we have Excel- and XML-based import procedures to automate the entry of patient data. Please see the ehepqual Data Import Guide and other data import specifications on ehepqual.org for additional instructions. We also recommend that you contact us at ehepqual@health.ny.gov if you plan to import data. In particular, we can provide additional guidance on how the import can be used as a preliminary step before keying in additional information or discuss options if your system can generate most but not all of the required indicator data. Click on the Reviews button at the top-left side of the application. This brings you to a list of existing reviews for your organization. Next to the entry for the current review, go to the Sample column and click on the blue underlined text. If you have not yet entered data for any patients, this will appear as 0 patients. If you need to delete an entire review, click on the garbage can icon. Note: be very careful when deleting a review. Once a review is deleted, any patient data associated with that review will also be deleted. Next, click on Add Patient After clicking Add Patient, you will be brought to the Patient Detail page, where you can add the required patient identifying information and demographics. 7
After entering all the required information, and clicking the Insert button you will come to this screen (see below). To continue to enter information for the same patient, click on the notepad icon to the left of the patient s name. You will see a list of available data entry screens. The Demographic screen is the first screen you already completed. Click on Hepatitis C Screening and Management to continue data entry. If you need to delete a patient, click on the garbage can icon to the right of the DOB. 8
(4) Entering Review Data After clicking on the notepad icon to select a patient and selecting Hepatitis C Screening and Management, you will be brought to the next data entry screen. Depending on the answers to particular questions, related questions will either appear or be hidden. The screenshot below shows all available questions. 9
Special Data Entry Tips for Hepatitis C Screening and Management screen: When entering lab dates from your EMR into the ehepqual (Question 1.2), you may see multiple dates in the patients records, including Collected Date, Received Date and Reported Date. If so, you should enter the Reported Date into the ehepqual system. If the actual lab result is not available but is documented in the physician s progress note, then enter the date of the progress note as the date of the lab test. There are two open-ended responses on this screen, Question 1.6.1 (Provider Name.) and Question 1.11.1.1 (Specify mixed combination). After providing this information in these fields, it is best to use the tab key to move to the next question. If you press enter while in this field you may find yourself moved to a calendar. If this happens, click anywhere in the screen and navigate to the next question. When everything on the Hepatitis C Screening and Management screen is complete, you can click on Update to save the data and exit, or Next to save the data and immediately enter other indicator data (Substance Use Screening) for this patient. When the Update or Next button is selected, a series of data validation rules will be activated. Violations of these rules will be described in red at the bottom of the screen. These issues must be resolved before you can save the record and proceed to the next screen. An example, where the date of the quantitative treatment adherence assessment (Question 1.12.1) was invalid, is below. In general, it will be easiest to keep track of how much work you have completed if all three data entry screens are completed in order for a single patient. The Next buttons at the bottom right of each indicator screen facilitate this, by moving you directly to the Substance Use Screening data entry screen if the patient had at least one positive RNA test. If a patient had no positive RNA test, the Substance Use Screening screen will not appear. 10
If the patient was a current substance user, information about substances and drug treatment and/or referrals for drug treatment will be asked. If patient was not a current substance user, a shorter list of questions will be asked. 11
Complete the data entry for all questions on the Substance Use Screening section, click Finish and then proceed to the next patient. If you need to return to data entry after taking a break, you can access the Review Patient List page by first clicking on Reviews (top-left corner of application) and then clicking on the name of the program (site) in the row that has the current review dates. Alternatively, you can also click on the number of patients in the Sample column to be returned to the list of patients included in the review. To help identify the last patient that was worked on, click on the word Modified to sort the list of patients by date/time last modified. Click on the notepad next to the last patient and make sure that all three data entry screens (Demographic, Hepatitis C Screening and Management, Substance Use Screening) were completed before proceeding to a new patient. All data that you enter are saved by clicking on Next or Finish. In case you unintentionally exit the application (e.g., your web session ends while you are attending to something else), we have implemented partial saves for some of the more complicated data entry pages. If you have entered data up to one of these save points (not visible to the user), this information will be preserved without your having submitted the data. 12
(5) Data Validation Data validation is a critically important step in the final certification of data quality. It is important to have a second person check all manual data collection forms for completeness and to review at least some forms for accuracy. Other steps are outlined below. Also see the Final Steps before Submitting guide for additional details on ways to review your data. To produce the Data Validation Report, follow these steps: 1 When logged into ehepqual, click on the Report List tab (top left-hand corner). 2 Under Reports, select {Name of desired report} 3 Under Review Period select the dates of the review (1/1/17-12/31/17). 4 Click on Report, at the bottom of the page. 5 Repeat for other components of the data validation process (see Final Steps before Submitting Data ) and other reports of interest. At a minimum, you should also review the Dashboard and All Indicators categories reports before submitting your data. 6 Review reports and correct data entry as indicated. Data Completeness The Consolidated Validation Report provides an overview of any problems that the application can automatically detect. Please note that final responsibility for the integrity of your submissions depends on your attention to any numbers that do not seem right and correction of any related errors of omission or commission. The total number of patients included in the sample is noted above the blue bar. Check that this number matches the sample size your program was asked to select. The column headings indicate collections of two or more of related variables and the cells show the number of records with missing or invalid data. 13
Click on the up/down arrows in each column heading to sort the records by that column. To scroll through multiple screens of records, or to download the report in a variety of formats, see the lower left portion of the toolbar. There may also be scroll bars on the bottom and right side of the data tables. Click on any blue underlined number to see a more detailed report of records and related variables. These more detailed reports are described below. The Detailed Patient Profile Data Validation Report shows all patients and all data entered on the Patient Details screen. For this and other validation reports, the ** symbols shows where there is no value for a patient for a given indicator or indicators. This means that no data were entered for the indicator and there should be. (If no data were expected for example, substance use counseling for a patient who has no substance use in their history the report prints -- instead.) Data highlighted in red flags other places where a value is out of range or not consistent with other entered data. In the example below, ** flags where the race is missing for a patient. The red Yes flags a patient who was reported to have no risk factors, and was also reported to have received blood before 1992. These two responses contradict one another and need to be resolved. The Data Validation Report: HIV/Hep B/Alcohol shows all data on HIV testing, hepatitis B assessment, and alcohol use screening. In the example, Patient Test1 is flagged because the patient reported not having HIV as a risk factor on the demographics screen, but was reported to have a positive HIV test on 1/2/11. 14
Patient test2 is flagged because the patient was reported as have HIV as a risk factor on the demographics screen, but was also reported to not have had an HIV test. The red dates that appear for patient Test1 indicate that the date is outside of the acceptable range of dates for each variable. The Validation Report: RNA Tests shows all patients and all data on HCV RNA testing and results. Dates highlighted in red may indicate that the date is outside the data collection period. The Data Validation Report: Medical Report shows all patients and all data on the medical provider, fibrosis and treatment barriers assessment. 15
The Data Validation Report: Treatment shows all patients and all data on HCV treatment, genotype testing and treatment adherence assessment. To see all the available variables, use the scroll bar on the bottom. In the example below, Patient Test1 has a medication date that is before the date of the first positive RNA. The Data Validation Report: Substance Use shows all patients and key data on the substance use screening page and substance use risk factors from the Patient Detail screen. To see all the available variables, use the scroll bar on the bottom. 16
These reports should be used to check both accuracy and completeness of data. Careful scanning of these reports may result in finding values that appear to be incorrect, for example, a patient known to be on medication may appear as not prescribed medication, or a patient may have been inadvertently indicated to have/or not have a particular risk factor because of a data entry mistake. It will be useful to print out this report periodically as you enter data, such as after every 5 or 10 patients, to identify possible errors in the data entry. Data Accuracy Once you have entered all the data for your sample, you should print out all the reports and review them carefully for accuracy. See Section (7) Generating Reports of this document for instructions on generating the reports. The questions to ask to ensure accuracy are: 1. Is the sample size correct for each report and indicator? Some reports and indicators are generated for the entire sample. This should be easy to check. Because a patient must have a positive HCV RNA test in order to eligible for review, the number of patients in the sample should match the number of patients with a positive HCV RNA result. Some indicators are only for a sub-sample, as patients completing HCV therapy during the review period. Sub-sample 17
reports will be easier to verify if you keep track of these patients during data entry. 2. Do the percentages make sense? ehepqual reports generally calculate a percentage for each indicator: the percentage of patients that received care in accordance with HEPQUAL quality standards. Of course this is part of what you want to find out by using ehepqual, but you probably already have a sense of what is happening in your clinic. Double check when the percentages seem too high or too low. 3. Are the results consistent? Data entry problems can sometimes lead to inconsistent results. Use the Detailed Data Validation Report to check values for the indicators for each patient and ensure they are consistent. 4. Did you upload data? If you uploaded data, rather than manually entering it, it will be necessary to look especially closely at the reports and the data file templates to make sure the data matches what was uploaded, and makes sense. If the data in the template file didn t conform to the system s skip rules, you may find discrepancies. For example, if there are more dates of alcohol assessments than there are patients reported as having an alcohol assessment completed, it will be necessary to edit the template file appropriately and re-upload the data. Refer to the Data Dictionary and ehepqual Data Collection Tools (with and without variable names) to see which questions need to be answered based on responses to previous questions, and which need to remain blank. 18
(6) Submit Data To formally submit a program s review, follow these steps: 1. At the Review tab, select the review period dates under the Define/Submit Reviews column. Fill out all of the required information. 1. Click on the blue hyperlink Read This Document to access the instructions for the final review of your data. 2.Confirm that the submission is complete. If so, select Yes from the dropdown list Ready to submit? 3.Click on the Update button below to complete the submission process. It will be reviewed by AIDS Institute staff, and you will receive an e-mail confirmation or additional guidance shortly. 19
(7) Generating Reports Generating and reviewing reports is an essential aspect of the ehepqual review process. This is the payoff for your work! To produce reports, click on the Report List button at the top left corner of the application, which brings you to the Report Selector page: Select the current review period. If you have more than one clinic, you will see a sample size equal to all patients. To run a report for a particular clinic or clinics, click on Selected Programs and select the intended clinic. If your patients are distributed among multiple sites, you can report on any subset of sites by clicking on Selected Programs and Ctrl/clicking on sites as desired. Regardless of the number of sites. The patient population can also be subdivided in various other ways using the filters available in the Lab Results and Patient Characteristics sections: age, gender, treatment status and four other additional criteria such as race, exposure risk, genotype etc. Any or all of these filtering techniques may be used in combination. See the following screenshots for examples of each report. 20
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Here s a simple example that restricts the report to male patients who were over 40 years old at the beginning of the review period: Once the desired sample has been established, producing a report is a simple matter of clicking on the report s name in the Report list and then clicking on the Report button at the bottom of the form. Once the report has been produced, it can be printed. The data can also be saved in a variety of formats, including PDF or Excel files, using the drop-down Select a format list at the top of the page, clicking on the Export link and then opening and saving the downloaded file to the desired location to save the file. Note: Reports with graphic elements (charts, tables, etc.) may display improperly on the screen when using browsers other than Internet Explorer. However, saving the report as a PDF file will generate properly formatted results. 25
OTHER REFERENCE MATERIALS A complete set of reference materials is available on the ehepqual Web site, www.ehepqual.org, including: 1. Announcements: 2. Webinars: 3. Registration Forms: ehepqual Organizational Security and Use ehepqual Individual Security and Use 4. Indicators: HCV Indicator Denominators and Numerators 5. Instructions: ehepqual Users Guide ehepqual Step-by-Step Chart Review Checklist ehepqual Sample Size Table Final Steps Before Submitting Data 6. Chart Abstraction Tools: ehepqual Data Collection Tool ehepqual Data Collection Tool with Variable Names 7. Data Import Guidelines: ehepqual Project Data Import Guide ehepqual Project Hierarchical Structure ehepqual Project Sample XML File (PDF) ehepqual Project Sample XML File (TEXT) ehepqual Project Import Definition ehepqual Project Data Dictionary ehepqual Project Excel Import Template ehepqual Project Sample Excel File CONTACT INFORMATION ehepqual@health.ny.gov 26